"Yes, just because he's a pharmaceutical graduate, he feels above us ordinary tumblers."

This
cartoon marks a transition in American medical history from the
hucksterism of patent medicine to the professionalism of the
pharmacy. The two tumblers (the name of both a type of glass and
an acrobat) dispense their patent medicines as part of a traveling
circus. Their rival is a beaker, whose enumerated form designates
scientific accuracy, while his walking stick and attitude convey a sense
of superiority.

Patent medicines are medicines legally sold without a
physician's prescription and usually protected by the manufacturer's
trademark. In the nineteenth century, government regulation of
medicine was virtually absent, and the practice of medicine was just
beginning the process of professionalization through mandatory medical
education, licensing, and peer review. At the same time, a rising
standard of living and the resulting increased longevity helped make
Americans more and more health-conscious. These factors opened the
way for patent medicine to become a growth industry in the nineteenth
century.

Manufacturers and
retailers often made unsubstantiated and exaggerated claims for the
concoctions they were peddling. The public was told that the patent medicines would cure cancer,
tuberculosis, arthritis, impotency, baldness, or simply that they were cure-alls
for a long list of maladies. Pervasive advertising, hopeful
expectations from patients used to folk remedies, and relative
inexpensiveness compared to prescription drugs, all combined to make
patent medicine a big business. The pills and potions, which might
contain cocaine, morphine, alcohol, or other addictive drugs, were sold
through the mail, in drug stores, and at traveling medicine shows like
the one lampooned in this cartoon. Some of the "patent"
medicines were not protected by trademark, and therefore their
ingredients were secret.

In 1821, the first school of pharmacy in the United States was
established at the University of the Sciences in Philadelphia. In
1852, the City of Brotherly Love was also the site for the founding of
the American Pharmaceutical Association. But for much of the
nineteenth century, anyone with a lecture room and a couple of textbooks
could run a medical or pharmacy school and award diplomas. Most
pharmacists at that time, however, entered the occupation through
apprenticeship without an educational degree.

In the nineteenth century, pharmacists, or druggists, bought
chemicals and drugs in bulk, measuring and mixing them in backroom
laboratories to produce medicines that filled prescriptions from
physicians. The attitude of pharmacists toward patent medicines was
complex. The unregulated concoctions undermined any quality control
by the druggist, and threatened to make his medical role entirely
obsolete. Yet, many pharmacists sold patent medicines in order to
survive financially. This practice caused tension with physicians
who abhorred the patent medicines.

Doctors also charged that druggists refilled prescriptions without
approval, or simply dispensed their own medicines without any
prescription. Pharmacists suggested that physicians place their
own house in order before criticizing druggists, since most patent
medicines carried a physician's endorsement. Medical societies,
however, increasing argued that doctors should fill their own
prescriptions, and the rise of wholesale drug manufacturers and the
development of the concentrated tablet made it easier to do so.
The doctor's medicine bag soon resembled a miniature pharmacy.

Beginning in the 1880s, and increasingly in the 1890s and
early-twentieth century, state legislatures started regulating pharmacy
and the rest of the medical profession. The requirements included
passing a state board examination in order to obtain the newly mandated
state license for practicing pharmacy (or medicine). In the 1890s, as reflected in this cartoon,
there was a push toward making a degree from an accredited pharmacy
school mandatory, and in 1900, the
American Association of Colleges of Pharmacy was founded. However,
state legislatures did not always require an accredited degree
until decades later.

In the late-nineteenth and early twentieth
centuries, the patent medicine
business came under fire as concern over drug and alcohol abuse grew,
and as muckraking journalists exposed patent-medicine scandals.
Congress passed the Pure Food and Drug Act in 1906 and the Harrison
Narcotics Act of 1914, both of which limited the possibility of unsafe
patent medicines entering the market.The patent medicine industry was also affected by national
prohibition under the Eighteenth Amendment in 1919, since so many of its
products used alcohol as a key ingredient.During the twentieth century, pharmacists increasingly became the
dispensers of drugs regulated by the government, manufactured by large
corporations, and prescribed by physicians.